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Reality MD

By Jock Hoffman, CRICO

Related to: Claims, Emergency Medicine, Primary Care, Nursing, Obstetrics, Other Specialties, Surgery

Does medicine-related TV influence public opinion? Are your patients expecting you to be a super diagnostician like, Dr. Gregory House or to be saved by unrealistic(1) ER heroics? Will the disease featured on the next Grey’s Anatomy prompt calls from patients who think they too might be afflicted? Are malpractice trial jurors who watch Boston Med of a different mindset than those more familiar with Scrubs?

Television loves medicine: the America public has been watching medical dramas and comedies since the 1950s. Baby boomers (i.e., the bulk of today’s patient population) grew up on romanticized Drs. Kildare, Casey, and Welby. Their children watched grittier dramas: M*A*S*H, St. Elsewhere, ER; and today’s offerings (Scrubs, Grey’s Anatomy, House) strive to be even more outlandish and cutting edge. And on the small screen, there’s little room for everyday sprains and strains: fictional patients’ health problems are almost universally extraordinary.

The drama and comedy of real health care delivery may satisfy those who actually practice it, but it won’t sell soap. Exaggeration and embroidery are necessary to keep audiences from reaching for the clicker. Main characters—especially doctors and nurses—have to be larger than life: outrageous, unflappable, brilliant, and gorgeous. And time on television is as precious as in a crowded clinic: a “one hour” TV episode has 42 minutes to introduce a patient, present her complaint, conduct a history and physical, run tests, make a diagnosis, and begin treatment or complete the necessary surgery. Real patients who have spent years watching fictional patients might well be frustrated by the more deliberate diagnostic and treatment processes they encounter.

Of course, the medical malpractice jury pool is also being influenced by the antics and heroics they witness from their sofas. Fortunately, real medicine is getting some air time. This summer, Boston Med is reprising the success of the 2008 documentary series, Hopkins, with eight episodes crafted from four months of footage filmed at three Boston (and CRICO-insured) hospitals: Massachusetts General, Brigham and Women’s, and Children’s. The heroes and the warts are real: not all of the patients are cured, but lives are saved dramatically; not every doctor or nurse is Hollywood attractive, but no one stumbles over medical terms or holds an instrument upside down; and when the credits roll and the camera lights go down, the real medical dramas continue.

No matter where patients acquire their notions about health care encounters, clinicians who assess their patients’ expectations and align them with their own will be better positioned to avoid situations in which a patient is frustrated by the absence of a miracle cure or disappointed by an outcome they’re unlikely to see on TV.

July 1, 2010
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